Therapeutic Effects of 35 kDa Hyaluronan Injection at Trigger Points in the Treatment of Myofascial Pain Syndrome

Abstract

Objectives : This study aimed to evaluate the prolonged therapeutic effects of a 35 kDa molecular weight hyaluronan fragment (HA35) in alleviating pain associated with myofascial pain syndrome (MPS). Hyaluronan interacts with various receptors in the human body, including CD44, LYVE-1, RHAMM, and TLR2, and is well-known for its analgesic effects when used in intra-articular or ultrasound-guided nerve trunk injections. Studies have shown that hyaluronidase cleaves high molecular weight HA to generate HA35, a low molecular weight fragment with enhanced tissue permeability, capable of binding to HA receptors on cell surfaces to produce broad-spectrum analgesic effects. Methods : Ten patients diagnosed with MPS were treated and assessed in this study. HA35 was administered through injection at a dosage of 100 mg daily for 15 days. Patients evaluated their MPS, overall pain levels, and treatment satisfaction using the Numerical Pain Rating Scale (NPRS), the Global Pain Scale (GPS), and the Treatment Satisfaction Questionnaire for Medication (TSQM 1.4). Follow-up evaluations were performed three months post-treatment to assess the duration of therapeutic effects. Results : Significant improvements were observed in NPRS, GPS, and TSQM scores both during and after the treatment period (P < 0.0001). The analgesic effect of HA35 was maintained throughout the three-month follow-up period. Conclusions : HA35 provides effective and sustained relief from pain associated with MPS, demonstrating a prolonged therapeutic benefit.